Provider Demographics
NPI:1669699302
Name:SUH, DAVID C (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SUH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25609 NARBONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2513
Mailing Address - Country:US
Mailing Address - Phone:310-326-8572
Mailing Address - Fax:310-326-1991
Practice Address - Street 1:25609 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2513
Practice Address - Country:US
Practice Address - Phone:310-326-8572
Practice Address - Fax:310-326-1991
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice